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Panel Says Zoloft and Cousins Don't Increase Suicide Risk

By GARDINER HARRIS

Published: January 22, 2004

Adding to the debate over using antidepressant drugs for depressed teenagers and children, a group of prominent researchers issued a report yesterday saying that Zoloft and similar medicines did not increase children's suicide risk.

The group, drawn from members of the American College of Neuro- psychopharmacology, also found that the drugs were effective in treating children's depression.

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"Depression in children and adults is the major illness that underlies suicide, and we believe that the S.S.R.I. class represents the medication with the greatest efficacy against this very serious condition," said Dr. J. John Mann, a professor of psychiatry at Columbia University who was co-chairman of the reporting panel.

Those conclusions are hotly contested, and the report does not settle the debate on giving children the medicines, selective serotonin reuptake inhibitors, or S.S.R.I.'s.

Citing associations between antidepressants and suicidal thoughts or tendencies in children, British drug regulators told doctors last month not to prescribe those drugs for children, with the exception of Prozac.

The Food and Drug Administration plans hearings on the question on Feb. 2.

In the new report, the panel reviewed 15 clinical trials, some unpublished, that included more than 2,000 teenagers and children as subjects. The trials used varying methods and had disparate outcomes, but showed that S.S.R.I.'s ó Effexor, Paxil, Prozac, Zoloft and others ó "are effective in treating depression in children and adolescents," the report said. It recommended that clinicians continue to use the drugs for depressed youths, although it said clinicians should "ask depressed patients about suicide, suicidal thinking and plans for suicide."

Dr. Jeffrey Lieberman, professor of psychiatry at the University of North Carolina, said he found the report persuasive.

"What the report said is that the risks of not treating patients with severe depressive illness outweighs the risk of treating them with S.S.R.I.'s," Dr. Lieberman said.

Dr. Richard Harrington, professor of child and adolescent psychiatry at the University of Manchester in England, said he was not sure that drugs were effective for teenagers and children.

"Maybe they work," Dr. Harrington said. "But if so, they don't work very well. And I'm still troubled by the suicidality."

Critics pointed to weaknesses in the report. The panel did not have access to some information that British regulators used to come up with opposite conclusions.

The report did not undertake a sophisticated and difficult meta-analysis, in which figures from many studies are pooled for examination. Other researchers are conducting that analysis.

Critics of the medicines noted that 9 of the 10 task force members had significant financial ties to the pharmaceutical industry, although such ties are common among prominent researchers. The panel said no industry money financed the report.

"Of course they concluded that these drugs are safe," said Tom Woodward, who said he believed the drugs led his daughter, 17, to commit suicide. "All these guys are tied to the pharmaceutical industry."

Worries that they might cause a small number of patients to become intensely suicidal have swirled about the drugs since shortly after Prozac was introduced. The question seemed to have been put to rest in 1991, after a Food and Drug Administration panel said there was no convincing evidence to link the drugs to increased suicide risk.

Millions of people have taken the medicines. Although sporadic complaints continued to link drugs to suicides, those reports were widely dismissed as anecdotal, isolated events that could not be relied on to assess the medicines. But later studies raised new questions.


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